Pneumothorax

Abnormal collection of air in the pleural space

Aetiology

Primary spontaneous pneumothorax (PSP)

  • No underlying lung disease
  • Usually the result of a rupture of a bulla
  • Risk factors - tall thin men, smokers (especially cannabis)

Secondary spontaneous pneumothorax (SSP)

  • Underlying lung disease

Other causes

  • Iatrogenic
  • Trauma

Pathophysiology

  • Abolishes transmural pressure gradient

Clinical presentation

Symptoms

  • Acute onset pleuritic chest pain
  • Dyspnoea

Signs

  • Hypoxia
  • Tachycardia
  • Reduced breath sounds and chest expansion on affected side
  • Hyper-resonance on percussion

Investigations

  • CXR

Management

  • No treatment if asymptomatic and small
  • Acutely unwell - aspiration (5th intercostal space, midaxillary line, safe triangle), if aspiration fails insert chest drain (5th intercostal space, midaxillary line)